Don’t jail addicts. Overdose prevention sites work, and the US needs to get on board

November 1, 2018

Today, 200 Americans likely will die from a drug overdose. Most of them will die alone.

The government’s modern-day response to our nation’s overdose epidemic has been woefully inadequate. Rather than relying on medical science, our leaders have been influenced by the same misguided approaches that undergirded the “war on drugs” in the 1980s — fear, stigma and racism.

We need a smarter strategy that reduces harm and saves lives. This starts with prosecutors ending the criminal crackdown on drug users — pushing for treatment instead of pressing charges; encouraging law enforcement to change street approaches; and, most of all, calling for the development of overdose prevention sites where people can consume substances under supervision, get clean needles, and get access to treatment and counseling.

These sites are saving lives in Canada and Europe, where they have been in operation since the 1980s. But the criminal stigma behind drug use and addiction has kept such sites from opening in the United States, leaving users to struggle and, far too frequently, die.

Not one overdose death

America’s opioid crisis has worsened in recent years due to the influx of fentanyl into the drug supply. In many cities, fentanyl has replaced heroin because it’s cheaper, easier to import, and offers the chance for enormous profits. There is no reason to think that this is temporary, that law enforcement alone will stop it, or that it will fix itself.

The traditional response to drug addiction has leaned on three pillars: prevention, treatment and law enforcement. We advocate for an additional pillar — harm reduction. This means working to save lives and to see the humanity behind each person and family impacted by the tragedy of addiction.

If you talk to police in cities hit hard by the drug crisis, they will quickly admit that arresting drug users will never slow down demand or reduce supply.

In Seattle, Philadelphia, Vermont and San Francisco, elected prosecutors are taking new approaches, despite threats of retaliation from the Trump administration. They know deaths will continue to mount until people have low-barrier access to a full spectrum of treatment and harm-reduction measures, including methadone and Suboxone, clean needles and overdose prevention sites (also called supervised consumption facilities and safe injection sites). Elected officials have, among other things, vowed to stop prosecuting users who have Suboxone without a prescription. Prosecutors have also come out in support of injection facilities.

Studies of more than 100 sites worldwide have shown that these facilities save lives. In fact, not a single overdose death has occurred in one since they began operating about three decades ago.

Facilities make financial sense, too

Canada offers a real-life example of the fiscal impact sites can have.

We led a delegation of prosecutors to Vancouver this month. What we saw on the city streets was disheartening, but overdose prevention sites offered a glimmer of hope.

Large areas downtown exemplify the extreme poverty and misery of fentanyl. We saw individuals struggling with homelessness (and in some instances facing physical and mental illness). Vancouver is working to address its homeless problem. But Insite’s medical professionals are trained to recognize and reverse overdoses, which they do, they said, 40 times a week. Cost-effective, tested solutions also minimize the spread of illnesses associated with needle sharing.

Despite this proven track record, they remain illegal in the US. Deputy Attorney General Rod Rosenstein recently vowed in a New York Times op-ed that the federal government would “meet the opening of any consumption site with swift and aggressive action.”

The primary argument against them is the so-called crack house statute of the Controlled Substances Act — the federal law that governs punishment for narcotics offenses. The law has been used to justify excessive punishment for crack offenses — a practice that has primarily targeted black men dating to the height of the war on the drugs in the 1980s. And the statute allowed officers to hone in on locations where users might have congregated. As misguided as the federal crack-cocaine laws may have been, they were never intended to clamp down on facilities set up to address a public health need.

Political opponents also claim that these sites are a magnet for illegal drug use and crime. Yet a person suffering from painful drug withdrawals does not need “encouragement” to use drugs. Vancouver’s overdose prevention sites have not increased neighborhood crime or the volume of drug users, according the city’s law enforcement and health professionals.

These same arguments were used to oppose decades-old needle exchange programs, which have become an effective public health strategy.

Federal efforts to block proven approaches signal a return to wrongheaded “tough on crime” policies and the politics of dehumanization that work to punish people with the disease of substance use disorder.

We have spent far too much time viewing drug users as unworthy of our care. Politicians need to set prejudice and fear aside and commit to saving lives. Stagnation is no longer acceptable.

Miriam Aroni Krinsky spent 15 years as a federal prosecutor and is the executive director of Fair and Just Prosecution, a national network of elected prosecutors committed to new thinking and innovation. Dan Satterberg is the elected prosecuting attorney for King County (Seattle) and has been a prosecutor for more than 30 years.